Utilidad de la ecotomografía doppler en el diagnóstico de la arteritis de células gigantes / Utility of the doppler ultrasound in the diagnostic approach of giant cell arteritis

Resumen: La arteritis de células gigantes es una vasculitis sistémica frecuente, especialmente en mayores de 50 años. Ante la sospecha clínica el diagnóstico debe ser confirmado con histología o estudios de imágenes. La biopsia de arteria temporal se considera el gold standard, sin embargo, tiene sus limitaciones, una de ellas es la alta tasa de falsos negativos. El estudio por ecotomografía Doppler permite la visualización de las arterias temporales y en manos experimentadas puede constituir un procedimiento diagnóstico alternativo a la biopsia en el estudio inicial de esta entidad. Esta técnica es de fácil acceso, bajo costo, sin riesgos y no expone al paciente a radiación ionizante. En este trabajo revisamos la utilidad clínica de la ecotomografía Doppler en el estudio de la arteria temporal y sus hallazgos imagenológicos en la aproximación diagnóstica a la arteritis de células gigantes, siendo las características de compromiso el engrosamiento parietal arterial hipoecogénico, habitualmente concéntrico, no compresible.

Abstract: Giant cell arteritis is a frequent systemic vasculitis, especially in patients older than 50 years old. When clinically suspected, the diagnosis should be made on the basis of histology or imaging methods. Temporal artery biopsy is considered the gold standard for the diagnosis but it has some caveats, especially the existence of false negatives. Doppler ultrasound study is a low cost, accessible tool that allows visualization of temporal arteries and, in experienced hands, can replace the biopsy in the initial evaluation of the disease, without the risks of ionizing radiation. In this article we review the clinical utility of the temporal artery Doppler ultrasound and its findings in the diagnostic approach of giant cell arteritis, being characteristic a non-compressible, hypoechoic, most commonly concentric arterial wall thickening.

Arteritis de células gigantes en el sistema vertebrobasilar, isquemias cerebelo-occipitales y parálisis III par: caso clínico / Giant cell arteritis of the vertebrobasilar system, posterior ischemia and palsy of the third nerve: report of one case

Giant cell arteritis is the most common vasculitis in patients aged over 50 years. We report an 89-year-old woman with significant weight loss and persistent frontal-occipital headaches lasting two months. The neurological examination at admission identified a decrease in visual acuity of the left eye, paralysis of the third cranial nerve of the right eye and alterations of body motility without objective signs of damage of the motor or sensitive pathways. Magnetic resonance imaging showed changes of the temporal artery wall and in both vertebral arteries, as well as bilateral cerebellar and occipital ischemic lesions. The Doppler ultrasound of the temporal arteries was compatible with Giant cell arteritis. Treatment with steroids was started. While receiving oral prednisone, the patient suffered new infarcts of the posterior territory, documented with a CAT scan.

Pseudoaneurisma traumático de la arteria temporal superficial, reporte de un caso / Traumatic pseudoaneurysm of the superficial temporal artery, report of a case

Los pseudoaneurismas son una causa infrecuente de masa palpable en cabeza y cuello, habitualmente secundarios a procedimientos intervencionales; trauma e infeccioso son casos aislados. Caso Clínico. Se presenta el caso de un niño de 14 años que luego de haber sufrido un trauma contuso cortante en la región preauricular izquierda intervenido quirúrgicamente, desarrolla al mes un aumento de volumen pulsátil tras un trauma menor en la zona. En la ecografía se aprecia el signo del yin yang, indicador de pseudoaneurisma. Se realiza en pabellón el vaciamiento del pseudoaneurisma y posterior sutura vascular sin incidentes. Discusión. Pese a la baja frecuencia de pseudoaneurisma como causa de masa en cabeza y cuello, se debe considerar como diagnóstico diferencial en el contexto de masas pulsátiles post traumáticas, de horas a días de evolución. El estudio de elección es la ecografía doppler y el Gold Standard del manejo es quirúrgico con sutura vascular.

Pseudoaneurysms are an infrequent cause of palpable mass in the head and neck; usually secondary to invasive procedures; trauma and infectious causes are rare. Clinical Case. We present the case of a 14-year-old boy who, after suffering a blunt contusive trauma in the left preauricular region surgically treated, develops a month later a pulsatile volume increase after a minor trauma in the area. Ultrasound shows the yin yang sign, indicator of pseudoaneurysm. The emptying of the pseudoaneurysm and subsequent vascular suture was performed without incident. Discussion. Despite the low frequency of pseudoaneurysm as a cause of mass in the head and neck, it should be considered as a differential diagnosis in the context of post-traumatic pulsatile masses, from hours to days of evolution. The study of choice is Doppler ultrasound and the Gold Standard treatment is surgery with vascular suture.

Pseudoaneurisma da artéria temporal superficial: relato de três casos / Pseudoaneurysms of the superficial temporal artery: three case reports

O pseudoaneurisma da artéria temporal superficial é um evento raro. Ocorre principalmente em homens jovens em decorrência de traumatismo craniano fechado. A maioria dos casos é assintomática, podendo eventualmente haver associação com sintomas vagos. A rotura do pseudoaneurisma e o desenvolvimento de déficits neurológicos são complicações esporádicas. Os autores relatam três casos de pseudoaneurisma de artéria temporal superficial pós-traumatismo craniano fechado. Os pacientes foram manejados com sucesso por ligadura e ressecção dos pseudoaneurismas

Pseudoaneurysms of the superficial temporal artery are rare events. They primarily occur in young men as a consequence of blunt head traumas. The majority of cases are asymptomatic, although there are sometimes vague symptoms. Ruptured pseudoaneurysms and development of neurological deficits are occasional complications. The authors describe three cases of pseudoaneurysm of the superficial temporal artery after blunt head trauma. Patients were successfully managed with ligature and resection of the pseudoaneurysms

Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant Cell Arteritis in an Elderly Korean Man

No abstract available.